| AIM:Epidemiological investigation of coronary heart disease is the main cause of death in China.Among them,acute myocardial infarction(AMI),in particular,is a serious threat to patients' life and quality of life.How to prevent and delay the progression of the disease is the primary goal of cardiologists.The presence of coronary collateral circulation(Coronary collateral circulation,CCC)is a good news for diagnosis and treatment of coronary heart disease.However,domestic and foreign research and progress reports are different.Studied in this paper based on the analysis of the AMI patients with anterior descending merging lesions of collateral circulation,effects on the cardiac function and left ventricular local activities and do correlation analysis,various factors affecting the formation of the coronary heart disease(CHD)for clinical treatment especially the AMI patients with anterior descending merging lesions.METHODS:Choose between January 2016 and December 2016 to our hospital treatment and the onset of AMI and for the first time through the anterior descending coronary angiography confirmed for lesions in 75%of patients with narrow or higher(exclude valvular disease,history of heart surgery,congenital heart disease,chronic cor pulmonale and other)in 447 cases.Coronary angiography(CAG)was performed within 24 hours of the onset of AMI and 10-14 days after onset,and the CAG was 1 group within 24 hours,and the CAG was 2 groups after 10 to 14 days.According to the CAG judgement about the classification of collateral circulation,divided the patients into a set of collateral circulation(A1 and A2 group)and no collateral circulation group(B1 and B2 group)and collateral good collateral circulation components group(C1 and C2 group:level 2,3)collateral circulation and adverse group(D1 and D2 group:0,1)collateral circulation.According to the results of cardiac ultrasound report(Simpson method),EF values were measured as cardiac function indexes and left ventricular local activity.The coronary angiography data and clinical data of the four anterior wall AMI patients were compared and analyzed.In addition,patients with collateral circulation were divided into high stenosis(75%-90%stenosis)and severe stenosis(>90%stenosis).The narrow parts were divided into three groups:proximal,middle and distal.It was divided into young group,middle-aged group and old age group by age 45 and 65.The history of diabetes was divided into diabetes group and non-diabetic group,and the relationship between the degree of stenosis and stenosis,age,diabetes and collateral circulation was analyzed.Logistic regression analysis was carried out on all factors related to CCC formation,and the factors that contributed to its formation were analyzed.Measurement data with mean +/-standard deviation(x±s)said,using t test or rank and inspection,counting information and rate by chi-square test,when n<40,using four table Fisher's exact probability method,the correlation analysis between the indexes is used Spearman correlation test,and apply Logistic regression analysis influence of anterior wall acute myocardial infarction,collateral circulation formation factors,adopts double side inspection,with P<0.05 was statistically significant,P<0.001 there are statistically significant differences.RESULTS:1.In the case of coronary artery stenosis,the circulation rate of the medial branch of AMI within 24 hours was 23.66%;After 10-14 days,the opening rate of branch circulation was 53.48%.There were statistically significant differences between the two groups at different time periods(?2=100.034,P<0.001).The high stenosis collateral circulation rate within of AMI 24 hours was 5.34%;The open circulation rate of severe stenosis was 18.32%.After 10-14 days,the high stenosis collateral circulation rate was 46.84%and the open circulation rate of severe stenosis was 6.65%.There was a significant difference in the rate of lateral branch circulation between the different stenosis degree.(?2=63.456,P<0.001).2.Coronary artery stenosis site as follows,the result of the opening of collateral circulation descending branch proximal lesion before 266,the total effective collateral circulation take rate was 53.38%,the middle section of the lesion is 121,total effective collateral circulation take rate was 41.32%,far segment lesions in 50 cases,total effective collateral circulation take rate was 16.00%.There was a significant difference in the opening rate of the lateral branch circulation between the coronary artery stenosis sites.(x2= 25.029,P<0.001).3.Age of the collateral circulation is the result as follows,young group a total of 56 cases,collateral circulation take rate was 30.36%,the middle age group 287 examples,collateral circulation take rate is 53.31%,elderly group 104 cases,collateral circulation take rate was 28.85%.There was a significant difference in the opening rate of the lateral branch circulation between the coronary artery stenosis sites(?2=23.838,P<0.001).4.Diabetes as the result of the formation of collateral circulation,a total of 314 cases of patients with diabetes,has opened 122 cases of patients with collateral circulation,collateral circulation take rate was 38.85%,there are a total of 133 patients with diabetes,has opened 78 cases of patients with collateral circulation,collateral circulation take rate was 58.65%.There was a statistically significant difference between the two groups(?2 = 97.582,P<0.001).5.The effect of collateral circulation on the cardiac function was significantly different between the two groups(t=-7.319,P<0.001)compared with the adverse group of the lateral branch circulation.6.Collateral circulation influence on left ventricular wall activity,good collateral circulation group,a total of 174 patients,154 cases of ventricular wall motion good,a total of 273 patients with poor collateral circulation group,201 cases of ventricular wall motion well,between the two groups have statistically significant difference between the(?2 = 176.723,P<0.001).7.May be related to the formation of collateral circulation factor Logistic regression analysis,it is concluded that Y(collateral circulation formation)=2.134-2.134(age)(diabetes)+ 1.770 + 1.061(vascular lesion count)+ 1.009(before infarction angina)CONCLUSION:1.The formation of collateral circulation is related to the degree of coronary artery stenosis,and the greater the stenosis,the greater the potential of lateral branch vessels.2.The formation of collateral circulation is related to the coronary artery stenosis,and the closer to the proximal vessels of the vessel,the greater the possibility of formation.3.Collateral circulation formation and the relationship between diabetes mellitus and diabetic patients with collateral circulation formed possibility is big,collateral circulation formation of patients with diabetes and middle-aged group is better than that of young and elderly group with diabetes.4.Patients with lateral branch circulation and good collateral circulation performed well in cardiac function and left ventricular wall activity.5.Logistic regression was used to analyze the formation factors of collateral circulation including age,diabetes,the history of angina pectoris before infarction,and whether it was diabetic.Besides age,it was the promotion factor of collateral circulation. |
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